低潮气量联合低呼气末正压通气对呼吸功能的影响

Effects of Low Tidal Volume Combined With Low Positive End-expiratory Pressure on Pulmonary Lobectomy During One Lung Ventilation

目的:观察低潮气量联合低呼气末正压通气用于肺叶切除术患者单肺通气的临床效果。方法:60例ASA I或Ⅱ级择期行肺叶切除术患者随机均分为A、B、C三组。A组:VT=6ml/kg,f=15次每分,加5cm H2O PEEP;B组:VT=8ml/kg,f=12次每分,加0cm H2O PEEP;C组:VT=8ml/kg,f=12次每分,加5cm H2O PEEP。记录单肺通气前(T1)、单肺通气后10min(T2)、单肺通气后30min(T3)及单肺通气后60min(T4)的动脉氧分压(PaO2)、动脉二氧化碳分压(PaCO2)、呼气末二氧化碳分压(PETCO2)及术中的气道峰压(Ppeak)、气道平台压力(Pplat)。结果:三组患者T2、T3、T4时点PaO2、PaCO2、PETCO2、Ppeak、Pplat与T1时点比较差异有统计学意义(P<0.05),T2、T3、T4时点A组的PaO2较B组、C组高,T2、T3、T4时点A组的PaCO2及PETCO2与B组、C组相比较能够维持基本正常,T2、T3、T4时点A组、B组的Ppeak及Pplat与C组相比较差异有统计学意义(P<0.05)。结论:肺叶切除术中应用低潮气量联合低呼气末正压通气能有效改善患者术中氧合,维持良好的通气功能,是肺叶切除术单肺通气期间的安全、有效通气方法。

Objective:To investigate the effects of low tidal volume combined with low positive endexpiratory pressure on Pulmonary Lobectomy during one lung ventilation(OLV).Methods:sixty patients with ASAⅠ-Ⅱ,scheduled for selective lobectomy were randomly divided into A,B,C groups with 20 cases each.During OLV,VT 6ml/kg,f15 bpm and combined With 0cm H2 O PEEP were chosen in group A;VT 6ml/kg,f15 bpm and combined With 5cm H2 O PEEP were chosen in group B;VT 6ml/kg,f15 bpm and combined With 8cm H2 O PEEP were chosen in group C.Blood gas analysis was determined before OLV(T1)and 10min(T2),30min(T3),60min(T4)after OLV.Results:There were significant differences in PaO2、PaCO2、PETCO2、Ppeak、Pplatat T2、T3、T4compared with T1 in three groups.Group A had higher PaO2 compared with group B and group C;group A had roughly normal PaCO2 and PETCO2at T2、T3、T4compared with group B and group C;Group C had higher Ppeakand Pplatcompared with group A and group B at T2、T3、T4.There were significant differences(P<0.05).Conclusion:Low tidal volume combined with low positive endexpiratory pressure on Pulmonary Lobectomy can improve oxygenation,maintain good ventilation function,and can be a safe and effective ventilation method during one lung ventilation.